ACA Advertising In 2014

Since the passage of the Affordable Care Act (ACA) in 2010, the law has been an often potent and divisive political issue, and has sparked an unprecedented amount of political and campaign advertising, particularly from candidates and groups that oppose the law. According to Kantar Media’s Campaign Media Analysis Group (CMAG), no other federal program or policy has resulted in the kind of advertising the ACA has caused, namely the combination of new insurance “product” advertising and sustained political advertising across multiple election cycles.

This year, Americans saw the launch of the ACA’s insurance market reforms, the implementation of the state and federal exchanges where people can shop for coverage and access subsidies, and the expansion of Medicaid in many states. Alongside these policy changes, new stakeholders began to advertise to encourage participation in the new coverage options, including state and federal governments, non-profit groups looking to boost enrollment, and health insurance companies seeking new customers. The mid-term elections have also brought a new collection of political advertising with ACA messaging. These two distinct types of advertising have different goals and aims; some encourage people to take advantage of new options under the ACA, while others encourage people to vote a certain way. With both of these types of advertising making their way into American living rooms in 2014, this analysis describes the full spectrum of ads that the American public is being exposed to regarding health care, both in the context of health insurance coverage, and as a political issue in the mid-term elections.

The analysis is based on data from Kantar Media’s Campaign Media Analysis Group and includes local television advertising in 210 media markets and national advertising across 10 broadcast and more than 80 cable networks (including Spanish-language networks) from January 1 through October 15, 2014. The data include campaign and political advertising mentioning the ACA as well as all health insurance advertising whether or not it explicitly mentions the law, such as ads from the U.S. Department of Health and Human Services (HHS), health insurance companies, and state exchanges. Unless otherwise noted, the analysis is based on the number of advertising “spots,” meaning each individual airing of an ad, rather than each unique ad. “Spots” reflect the amount of advertising that has aired and thus possibly viewed by the American public. At times, the report refers to “unique” ads, meaning individual ads about a candidate or a specific insurance product that may have aired many times. The report also includes public opinion survey results from Kaiser Health Tracking Polls, which provide insight into what types of ads and media messages people across the country report seeing.

Key Findings

In this unique year of both Congressional midterms and the first open enrollment periods under the Affordable Care Act, insurers, exchanges, HHS, political campaigns and issue groups have taken to the television airwaves to encourage people to enroll in coverage, market health insurance products, and suggest Americans vote certain ways. This report analyzes both health insurance ads and political ads referencing health care, particularly those that refer to the ACA, that aired between January 1 and October 15, and includes the following key findings:

During the first 9 and a half months of 2014, over 1.3 million health insurance and political ads that reference health care issues aired, about half of which reference the Affordable Care Act. Many of these ads do not mention the law by name, but rather refer to the law as “Obamacare” or talk about one or more of the law’s specific provisions.

Of all political ad spots in 2014 so far, 26 percent specifically mentioned health care issues, including 14 percent that specifically mention the ACA, most of which were negative in their reference to the law.

Republicans included ACA messaging in 84 percent of their political ad spots that cover health issues, compared to 15 percent for Democrats.

The ACA is rarely mentioned alone in political advertising; 74 percent of ACA political ad spots mention other issues, such as the economy or social issues.

Half of health insurance advertising does not mention the ACA, while 34 percent of spots mention the ACA in a neutral way, 15 percent in a positive way and 1 percent in a negative way.

Ads Referencing The Affordable Care Act

There are two types of advertising described in this report that include messaging related to the Affordable Care Act – health insurance ads and political ads.

Health Insurance Ads: Health insurance advertising includes ads from health insurers promoting their products as well as advertising from the U.S. Department of Health and Human Resources, state exchanges, and enrollment advocacy groups encouraging people to get covered. Insurance ads are divided into the following two groups:

Insurance Ads That Use The ACA: These ads mention the law by name, cover topics directly related to the law, or refer to a specific provision. Many enrollment and coverage ads from exchanges or enrollment groups do not use the law by name, but are still considered ACA-ads because they refer to coverage available under the law. Within this category there are ads that are positive toward the ACA, those that are negative, and those that remain neutral. Pro-ACA Insurance Ads promote the law overall or champion certain aspects of the law. Anti-ACA Insurance Ads often point out problems people may have had trying to get information or enroll. Neutral ACA Insurance Ads are more tempered in their reference of the law or its provisions, often routing people to where they can find more information.

Insurance Ads That Do Not Use The ACA: These ads are primarily sponsored by insurers selling their products with no reference to the law or its provisions.

Political Ads: Campaign or political advertising includes ads from candidates, political parties, political action committees, or issue groups advertising for upcoming elections. In order to be classified as an ad that used the ACA in its messaging, political ads do not necessarily have to mention the law by name. Many ads reference “Obamacare” or “Obama’s health care plan,” particularly Republican-affiliated ads, while others mention specific provisions of the law, something Democrats have been prone to do in their relatively limited ACA advertising. Anti-ACA Political Ads are decidedly negative toward the law and its effect on the American people or the nation. Pro-ACA Political Ads hold the law in a positive light, often referring to changes in how insurers do business and access to coverage for those with pre-existing conditions.